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Treatment of Profound Hypothermia

David E. Welton, MD; Kenneth L. Mattox, MD; Richard R. Miller, MD; Fredrick F. Petmecky, MD
JAMA. 1978;240(21):2291-2292. doi:10.1001/jama.1978.03290210073038.
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MANY lives were lost due to accidental hypothermia during the severe winters of 1977 and 1978. The alcoholic, the trauma victim, and the elderly with underlying medical disorders are at risk of losing consciousness outdoors and therefore are prone to the development of this medical emergency.1

Severe hypothermia depresses the CNS, the medullary respiratory center, and the cardiovascular system.2 The profoundly hypothermic patient is comatose and hyporeflexive. Ventilatory drive is reduced, resulting in hypoxemia. Respiratory arrest occurs at temperatures of less than 24°C (75°F). In addition, there is hypotension due to low cardiac output and cardiac abnormalities such as atrial fibrillation, atrial flutter, conduction defects, premature ventricular contractions, and junctional rhythms. The ECG may show T-wave inversion and prolonged PR, QRS, and QT intervals as well as the unique "J" wave at the end of the QRS complex3 (Figure). In patients with moderate


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